“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI

“CHANGING CARE WITH CHANGING BODIES AND

CHANGING NEEDS !

“CHANGING CARE WITH CHANGING BODIES AND

CHANGING NEEDS !

- A health awareness module for women

- A health awareness module for women

Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS

Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS

04/19/23Dr.Maninder Ahuja,dr.Duru shah

“The woman is an axle around whom not only the family or society but the whole universe revolves”.

Her health is of utmost

importance in all stages of

her life….. more so in menopause

“The woman is an axle around whom not only the family or society but the whole universe revolves”.

Her health is of utmost

importance in all stages of

her life….. more so in menopause

A Woman is the pivot of the Universe!

A Woman is the pivot of the Universe!


““Fit at 40”Fit at 40”““Fit at 40”Fit at 40”

““Independent at Independent at 80”80”

““Independent at Independent at 80”80”

““Strong at 60”Strong at 60” ““Strong at 60”Strong at 60”

We have changedWe have changed

toto

toto

fromfrom

04/19/23Dr.Maninder Ahuja,dr.Duru shah3

Our AimOur Aim• offer a better quality of Life• Prevent disabilities• Functional independence• Prevent cancers• Treat Medical & other menopausal problems

• offer a better quality of Life• Prevent disabilities• Functional independence• Prevent cancers• Treat Medical & other menopausal problems


Why is Menopause so significant?Why is Menopause so significant?Because the no. of years lived after menopause is increasing Because the no. of years lived after menopause is increasing

The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries

1/3rd of a woman’s life is spent after Menopause.

The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries

1/3rd of a woman’s life is spent after Menopause.

Year

1850 1900 1950 20000

20

40

80

60Age

(Year)

Source: US Dept of Health and Human Services; 1999;47(28).04/19/23Dr.Maninder Ahuja,dr.Duru shah5

Comparison of post menopausal women worldwide over the yearsComparison of post menopausal women worldwide over the years

Source : World Bank ReportSource : World Bank Report

1990 By 2030

Worldwide population

470 million 1.2 billion

Developed countries

40% 24%

Developing countries

60% 76%


Menopause defined Menopause defined

•There should be absence of menses for 12 months

•Average age 46-51 years

•Can be surgically induced

•Premature menopause before 40 years of age

•There should be absence of menses for 12 months

•Average age 46-51 years

•Can be surgically induced

•Premature menopause before 40 years of age 04/19/23Dr.Maninder Ahuja,dr.Duru shah

7

Menopause – its implications

Menopause – its implications•Ovaries do not

produce eggs!

•Estrogen levels fall

•No periods•No pregnancy


There are always two sides of a coin

There are always two sides of a coin


Women’s perception of menopause

Women’s perception of menopauseVaries from person to personVaries from person to person

Positive • Relief from monthly period• No contraception No contraception required required • No pregnancy No pregnancy worries worries• Advantages of Advantages of senior citizen in senior citizen in society society

Positive • Relief from monthly period• No contraception No contraception required required • No pregnancy No pregnancy worries worries• Advantages of Advantages of senior citizen in senior citizen in society society

Negative • Fear of old age • Isolation and loneliness• Disturbance by symptoms of menopause & changing body image

Negative • Fear of old age • Isolation and loneliness• Disturbance by symptoms of menopause & changing body image


Why do we reach menopause?

Why do we reach menopause?• At puberty, the ovaries At puberty, the ovaries

produce two female produce two female hormones, hormones, estrogen and estrogen and progesterone progesterone and a maleand a male hormone, hormone, androgen.androgen.• Gradually, as a woman Gradually, as a woman approaches her midlife approaches her midlife years, years, the production of these the production of these hormones slows down and hormones slows down and

eventually stops eventually stops altogetheraltogether at menopause. at menopause.

Contd..


HormonesHormones

ESTROGENSESTROGENS

PROGESTRONESPROGESTRONES

ANDROGENSANDROGENS


Role of EstrogenRole of Estrogen

Estrogen is the “female” hormone responsible for the change from girlhood to womanhood

Estrogen is the “female” hormone responsible for the change from girlhood to womanhood

Contd..Contd..

04/19/23Dr.Maninder Ahuja,dr.Duru shah 13

Role of ProgesteroneRole of Progesterone

Progesterone is the hormone which helps to support a pregnancy if it occurs

Progesterone is the hormone which helps to support a pregnancy if it occurs

Contd..Contd..Contd..Contd..


Role of AndrogensRole of Androgens

Androgen is the hormone responsible for the growth of axillary and pubic hair, mood and desire for sex

Androgen is the hormone responsible for the growth of axillary and pubic hair, mood and desire for sex

Contd..Contd..


The female hormone -estrogen

The female hormone -estrogen It helps

• To maintain the body shape of a woman

• To regulate monthly periods• To keep the tissues of skin, blood

vessels & reproductive tract healthy

• To regulate mood and behavior patterns

• To promote sex drive• To keep cholesterol levels lower• To preserve bones

It helps • To maintain the body shape of a

woman• To regulate monthly periods• To keep the tissues of skin, blood

vessels & reproductive tract healthy

• To regulate mood and behavior patterns

• To promote sex drive• To keep cholesterol levels lower• To preserve bones 04/19/23Dr.Maninder Ahuja,dr.Duru shah

16

Menopause comes in phases!

Menopause comes in phases!

Premenopause-regular cycles, fertility maintained Premenopause-regular cycles, fertility maintained

Peri menopause-irregular cycles, may have symptoms fertility suboptimal

Peri menopause-irregular cycles, may have symptoms fertility suboptimal

MenopauseMenopause – No periods for 12 months, may have No periods for 12 months, may have symptoms – no fertility symptoms – no fertility

MenopauseMenopause – No periods for 12 months, may have No periods for 12 months, may have symptoms – no fertility symptoms – no fertility


Initially 7 symptoms were associated with menopauseInitially 7 symptoms were

associated with menopause


But now this mid life crisis has

about 35 symptoms!

But now this mid life crisis has

about 35 symptoms!VASOMOTOR SYMPTOMS

• Hot flushes

• Mood changes

• Depression

• Sleep disturbances

• Fatigue

VASOMOTOR SYMPTOMS

• Hot flushes

• Mood changes

• Depression

• Sleep disturbances

• Fatigue Contd..Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah

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Symptoms contd..Symptoms contd..

UROGENITAL SYMPTOMS

• Dryness of vagina

• Dysuria

• Urinary Leak

• Urinary Frequency

• Sexuality problems

UROGENITAL SYMPTOMS

• Dryness of vagina

• Dysuria

• Urinary Leak

• Urinary Frequency

• Sexuality problems Contd..Contd..


MUSCULOSKELETAL

• Sarcopenia / weakness of muscles

• Joint aches and pains

• Osteoarthritis

• Osteoporosis

MUSCULOSKELETAL

• Sarcopenia / weakness of muscles

• Joint aches and pains

• Osteoarthritis

• OsteoporosisContd..Contd..



• Menstrual irregularities

• Unintended pregnancy

• Palpitation

• Muscle and joint pain

• Low backache

• Dryness of skin

• Hair loss, nail problems

• Eye problems

• Gum and teeth problems

• Menstrual irregularities

• Unintended pregnancy

• Palpitation

• Muscle and joint pain

• Low backache

• Dryness of skin

• Hair loss, nail problems

• Eye problems

• Gum and teeth problems



Long term problemsLong term problems

Forgetfulness,Alzheimer’sOsteoporosis Heart disease

OTHERSOTHERS

ArthritisArthritis Diabet

esDiabetes

HypertensHypertensionion

Problems of Hearing, visionProblems of Hearing, vision Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah

23

Long term problemsLong term problems

METABOLIC

• Increased risk of CHD

• Hypertension

• More chances of diabetes

• Alzheimer / loss of memory

METABOLIC

• Increased risk of CHD

• Hypertension

• More chances of diabetes

• Alzheimer / loss of memory


These cancers are not because of menopause but are there in this age group

Cancer cervix Cancer breast Cancer ovaries Cancer endometrium


Some Myths and FactsSome Myths and Facts

Myth Myth - - Menopause is natural Menopause is natural with no clinical with no clinical consequencesconsequences

Myth Myth - - Menopause is natural Menopause is natural with no clinical with no clinical consequencesconsequences

Fact – It does have clinical consequences

Fact – It does have clinical consequences

Contd..Contd..


Some myths and factsSome myths and facts

Myth - No treatment is necessary

Myth - No treatment is necessary

Fact - Treatment is necessary for a better quality of life

Fact - Treatment is necessary for a better quality of life

Contd..Contd..



Myth - Menopausal women should not be offered HRT

Myth - Menopausal women should not be offered HRT Fact -

HRT is definitely recommended as an option for symptomatic menopausal women

Fact - HRT is definitely recommended as an option for symptomatic menopausal women Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah

28


Myth – Menopause has no effect on mental health

Myth – Menopause has no effect on mental health Fact -

Menopause and low estrogen levels are associated with depression

Fact - Menopause and low estrogen levels are associated with depression


What are hot flushes?What are hot flushes?

• Feeling of “heat” in the Feeling of “heat” in the face & upper body face & upper body followed by cold sweats followed by cold sweats• Can occur any time in theCan occur any time in the day or night day or night• Can disturb sleepCan disturb sleep• Can cause feeling of Can cause feeling of fatigue fatigue• Can be accompanied by Can be accompanied by irritability, mood irritability, mood swings, depression swings, depression

• Feeling of “heat” in the Feeling of “heat” in the face & upper body face & upper body followed by cold sweats followed by cold sweats• Can occur any time in theCan occur any time in the day or night day or night• Can disturb sleepCan disturb sleep• Can cause feeling of Can cause feeling of fatigue fatigue• Can be accompanied by Can be accompanied by irritability, mood irritability, mood swings, depression swings, depression


What can be done?What can be done?

• Wear loose clothes Wear loose clothes preferably inlayers preferably inlayers• Cool down the Cool down the body temperature body temperature with moist wipes with moist wipes• Try to relaxTry to relax• YogaYoga• Meditation Meditation

• Wear loose clothes Wear loose clothes preferably inlayers preferably inlayers• Cool down the Cool down the body temperature body temperature with moist wipes with moist wipes• Try to relaxTry to relax• YogaYoga• Meditation Meditation


Other methods to prevent hot flushes

Other methods to prevent hot flushes

The following are suggested to reduce an attack• Avoid spicy food• Avoid coffee, tea, alcohol• Eat lentils, Soya products,• Wear loose cotton clothes• Avoid hot water bath just before sleeping• Alternative medicines like isoflavones• Medical treatment options like Hormone therapy

The following are suggested to reduce an attack• Avoid spicy food• Avoid coffee, tea, alcohol• Eat lentils, Soya products,• Wear loose cotton clothes• Avoid hot water bath just before sleeping• Alternative medicines like isoflavones• Medical treatment options like Hormone therapy


Vaginal symptomsVaginal symptoms

• Vaginal drynessVaginal dryness

• ItchingItching

• IrritationIrritation

• Pain on urinationPain on urination

• Discomfort Discomfort associated associated with sexual activity with sexual activity

• Bleeding during Bleeding during intercourse intercourse

• Vaginal drynessVaginal dryness

• ItchingItching

• IrritationIrritation

• Pain on urinationPain on urination

• Discomfort Discomfort associated associated with sexual activity with sexual activity

• Bleeding during Bleeding during intercourse intercourse 04/19/23Dr.Maninder Ahuja,dr.Duru shah

33

Urinary problems in menopause

Urinary problems in menopause• Leak of urine on

coughing, sneezing, bending - stress urinary incontinence – a social problem• Unable to hold urine – urge incontinence• Frequency in urination• Retention with overflow

• Leak of urine on coughing, sneezing, bending - stress urinary incontinence – a social problem• Unable to hold urine – urge incontinence• Frequency in urination• Retention with overflow 04/19/23Dr.Maninder Ahuja,dr.Duru shah

35

Management of urogenital symptoms

Management of urogenital symptoms

• Water based lubricants/no baby creams or hand lotions

• Local estrogen preparations• For urinary symptoms, bladder diary• Urine examination • Tests for incontinence• Kegels exercises• Surgery• Bladder training

• Water based lubricants/no baby creams or hand lotions

• Local estrogen preparations• For urinary symptoms, bladder diary• Urine examination • Tests for incontinence• Kegels exercises• Surgery• Bladder training



• Minimally-invasive and simple surgical option to treat incontinence

• Completed in 30 minutes can be done under local anesthesia

• Patient returns home the same day• Minimal post-op pain • 96% success rate

– 85 % patients completely cured

– 11% patients experience significant improvement

• Minimally-invasive and simple surgical option to treat incontinence

• Completed in 30 minutes can be done under local anesthesia

• Patient returns home the same day• Minimal post-op pain • 96% success rate

– 85 % patients completely cured

– 11% patients experience significant improvement

Reduced sexual desireReduced sexual desire

DYSPAREUNIADYSPAREUNIADYSPAREUNIADYSPAREUNIA

Reduction ofReduction oforgasmic orgasmic capacitycapacity

Reduction ofReduction oforgasmic orgasmic capacitycapacity

ReduceReducesexualsexual

satisfactionsatisfaction

ReduceReducesexualsexual

satisfactionsatisfactionNegativelyNegativelyinfluencinginfluencing

sexualsexualmotivationmotivation

NegativelyNegativelyinfluencinginfluencing

sexualsexualmotivationmotivation

Decline inDecline inlibidolibido

Decrease Decrease frequencyfrequency

less less lubricationlubrication

Decrease Decrease frequencyfrequency

less less lubricationlubrication


ManagementManagement

• Lubricating jelliesLubricating jellies

• Estrogen Vaginal Estrogen Vaginal

cream cream

• Mood elevatorsMood elevators

• Hormone Hormone replacement replacement therapy therapy


Remaining in Part 2

Remaining in Part 2


Documents

“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI